Human milk is the ideal nourishment for infants’ survival, growth, and development. Particularly in unhygienic conditions, however, breast milk substitutes carry a high risk of infection and can be fatal in infants [
Exclusive breast feeding in the first six months of life stimulates babies’ immune systems and protects them from diarrhea and acute respiratory infections [
The world health organization (WHO) recommends exclusive breast feeding (EBF) for the first six months of life while it is advised to provide adequate and safe complementary foods with breast feeding for up to two years and beyond. EBF remains uncommon in most countries (both developed and developing), even in countries with high rates of breast feeding initiation. EBF rates in infants less than six months of age varied from as low as 20% in central and eastern European countries to 44% in south Asia [
In Africa, more than 95% of infants are currently breastfed, but feeding practices are often inadequate; feeding water and other liquids to breastfed infants is a widespread practice [
Institutional based descriptive cross-sectional study was conducted from March 10–30/2016 Gc.
This study was conducted in Dabat Health Center. Dabat is found in northeast of Gondar 814 km far from Addis Ababa, the capital city of Ethiopia, and about 70 km from Gondar, the administrative town of North Gondar zone. It is about 2700 m above sea level. Currently, it has one health center and 3 health posts in the town plus 5 health posts around it. The current population is about 49,000.
Participants were all mothers visiting antenatal care and immunization clinic in Dabat Health Center during data collection.
We used single population proportion formula by taking proportion of knowledge of mothers towards exclusive breast feeding 65.1% from the previous research [
Data collection instruments consist of sociodemographic questionnaire (age, religion, ethnicity, marital status, educational status, occupation, residency, parity, gravidity, and ANC). To assess knowledge about exclusive breast feeding (EBF), nine knowledge questions were used (knowledge about exclusive breast feeding, the right time to give breast milk to a child after birth, what you do with the first milk or colostrum, right time to start complementary foods in addition to breast, foods and/or fluids recommended to give to a child under 6 months, if prelacteal feeding needed for an infant before starting breast milk, breast milk alone without water and other liquids being enough for an infant during the first 6 months of life, and exclusive breast feeding for the first 6 months being used to prevent diarrheal and respiratory diseases for the infant) and for assessment of attitude based on Likert scale (1 = strongly agree, 2 = agree, 3 = disagree, and 4 = strongly disagree) [
A structured and pretested interviewer administrated questionnaire was used to gain data from study participants. First the questionnaire was translated to Amharic language which is a local language in understandable way to exclude misunderstanding to assure data quality. The questionnaire includes sociodemographic characteristics, knowledge, and attitude of study participants towards EBF.
Data quality was assured by using different approaches. First adequate orientation was provided for data collectors. After that, 5% of the questionnaires were pretested on volunteer mothers who have similar characteristics with study population in the same area who are not included in the study. After pretest, some questions were modified.
After checking the completeness and appropriateness, the data were entered and coded into SPSS version 20.0 statistical package software for analysis. The result is presented in the form of frequencies and percentages by using tables, charts, and text.
Ethical clearance was obtained from University of Gondar, College of Medicine and Health Sciences School of Nursing. All process was started after securing written permission from the School of Nursing Office. A permission letter obtained from School of Nursing was submitted to Dabat Health Center Office which is involved in the study. The study subjects were informed clearly and in detail about the importance of the study and a written consent was obtained. They have the right to refuse and withdraw from participating in the research without any explanation and they have the right to ask any question any time. In addition, the name of the study subjects was not included in the questionnaires which would address concern of the study subject.
A total of 384 mothers were interviewed successfully in this study which makes the response rate 100%. Majority of study participants were in the age groups of 20–30 (66.9%) and the mean age was 27.65, 325 (84.6%) were Orthodox Christianity followers, 56 (14.6%) were Muslims, and 3 (0.8%) were Protestants. Majority were Amhara ethnicity 370 (96.4%), 322 (83.9) were married, 33 (8.6%) were living together, 114 (29.7%) were not able to read and write, and 78 (29.7) completed secondary school. 173 (45.1%) were housewives and 82 (21.4%) were government employee. Majority 199 (51.8%) had four times ANC follow-ups. Eighty point five percent had 1–3 gravidity, and 67.7% had parity of 1–3. Majority (63.5%) of the respondents were urban dwellers while 36.5% lived in the rural areas (Table
Sociodemographic characteristics of the respondents in Dabat Health Center, Northwest Ethiopia, 2016.
Characteristics | Frequency | Percent (%) |
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Ages of respondents | ||
<20 | 28 | 7.3 |
20–30 | 257 | 66.9 |
31–40 | 93 | 24.2 |
>40 | 6 | 1.6 |
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Religion | ||
Orthodox | 325 | 84.6 |
Muslim | 56 | 14.6 |
Protestant | 3 | 0.8 |
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Ethnicity | ||
Amhara | 370 | 96.4 |
Tigray | 11 | 2.8 |
Agew | 3 | 0.8 |
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Marital status | ||
Married | 322 | 83.9 |
Single | 33 | 8.6 |
Divorced | 19 | 4.9 |
Widowed | 10 | 2.6 |
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Educational status | ||
Not able to read and write | 114 | 29.7 |
Can read and write (informal education) | 58 | 15.1 |
Formal (1–8) | 62 | 16.1 |
Secondary school (9-10) | 78 | 20.3 |
10 + 2 and above | 72 | 18.5 |
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Occupational status | ||
Government employee | 82 | 21.4 |
Private employee | 15 | 3.9 |
Daily laborer | 37 | 9.6 |
Housewife | 173 | 45.1 |
Housemaid | 12 | 3.1 |
Merchant | 31 | 8.1 |
Farming | 34 | 8.9 |
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Residency | ||
Urban | 244 | 63.5 |
Rural | 140 | 36.5 |
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Parity (1–3) | 244 | 63.5 |
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Gravidity (0–3) | 309 | 80.5 |
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ANC | 199 | 51.8 |
From the total study participants, based on knowledge score, 268 (69.8%) of the respondents were grouped as having good knowledge and 116 (30.2%) of the study participants were categorized as having poor knowledge. Three hundred fifteen (82%) knew about EBF and 69 (18%) do not know about EBF. Their major source of information was health institutions 255 (66.4%). Two hundred sixty-nine (70%) have good knowledge about right time to give breast milk to a child after birth.
One hundred seventy-four (45.3%) of the respondents have poor knowledge to give the first milk (colostrum) to the newborn, while 210 (54.7%) have good knowledge about it. The majority 250 (65.1%) knew that breast milk alone is enough for infants less than 6 months but 99 (25.8%) answered that breast milk alone is not enough for the infant under 6 months. Two hundred thirty-four (60.9%) of the participants knew that EBF prevents diarrheal and respiratory diseases as it is shown in Table
Knowledge of study participant mothers towards exclusive breast feeding, Dabat Health Center, Northwest Ethiopia, 2016.
Variables | Frequency | Percent (%) |
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Do you know about exclusive breast feeding? | ||
Yes | 315 | 82 |
No | 69 | 18 |
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Source of information | ||
Friends | 10 | 2.6 |
Mass media | 59 | 15.4 |
Health institution | 255 | 66.4 |
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Right time to give BM to a child after birth | ||
After giving some butter | 31 | 8.1 |
Within an hour | 269 | 70 |
After one hour | 54 | 14.1 |
After 24 hours | 30 | 7.8 |
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What do you do with the first milk or colostrum? | ||
Discard | 174 | 45.3 |
Feed immediately | 210 | 54.7 |
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Right time to start complementary foods | ||
3 months | 10 | 2.6 |
4 months | 34 | 8.8 |
5 months | 23 | 6 |
6 months | 311 | 81 |
7 months or above | 6 | 1.6 |
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Foods or fluids recommended to under 6 months’ child | ||
Only breast milk | 236 | 61.5 |
Breast milk and/or water or sugar | 113 | 29.4 |
Infant formula | 7 | 1.8 |
Others | 28 | 7.3 |
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Is prelacteal feeding needed? | ||
Yes | 75 | 19.5 |
No | 292 | 76.1 |
I do not know | 17 | 4.4 |
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BM alone is enough for infant < 6 months of life | ||
Yes | 250 | 65.1 |
No | 99 | 25.8 |
I do not know | 35 | 9.1 |
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EBF prevents diarrheal and respiratory diseases | ||
Yes | 234 | 60.9 |
No | 62 | 16.2 |
I do not know | 88 | 22.9 |
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Knowledge score | ||
Good | 268 | 69.8 |
Poor | 116 | 30.2 |
From this study based on the attitudinal score, 92 (24%) of the study participants were categorized as having negative attitude towards EBF and 292 (76%) were categorized as having positive attitude towards EBF. From study participants, 109 (28.4%) and 130 (33.9%) of them strongly disagree and disagree to the opinion discarding colostrum (first milk), respectively. For the opinion that starting complementary foods before 6 months is important, 12% strongly agree, 15.9% agree, 44% disagree and, 28.1% strongly disagree (Table
Attitude of study participant mothers towards exclusive breast feeding (EBF) in Dabat Health Center, Northwest Ethiopia.
Variables | Frequency | Percent |
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Giving BM for a newborn immediately within an hour is important | ||
Strongly agree | 48 | 12.5 |
Agree | 63 | 16.4 |
Disagree | 182 | 47.1 |
Strongly disagree | 92 | 24 |
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Discarding the first milk or colostrum is important | ||
Strongly agree | 55 | 14.3 |
Agree | 90 | 23.4 |
Disagree | 130 | 33.9 |
Strongly disagree | 109 | 28.4 |
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Only BM may not be sufficient for 3 months’ child | ||
Strongly agree | 56 | 14.6 |
Agree | 87 | 22.6 |
Disagree | 150 | 39.1 |
Strongly disagree | 91 | 23.7 |
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Starting complementary foods before 6 months is important | ||
Strongly agree | 46 | 12 |
Agree | 61 | 15.9 |
Disagree | 169 | 44 |
Strongly disagree | 108 | 28.1 |
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Attitudinal score | ||
Positive | 292 | 76 |
Negative | 92 | 24 |
This study shows that mothers who have good knowledge towards EBF are 69.8% which is higher than a study conducted in Abha city, Saudi Arabia, which was 55.3% [
In the current study, the knowledge of initiation of breast feeding is 70% which is less than that from a study conducted in Mizan Aman town of Ethiopia that was 73.3% [
Knowledge of respondents on colostrum in this study is 54.7% (having good knowledge). This is less than a study conducted in Mangalore which was 86.6% and in a study conducted in Mizan Aman town of Ethiopia that was 60.2%. This difference might be due to the difference of sample size.
In this study based on the attitudinal score, 76% of the respondents have positive attitude towards EBF, while 24% have negative attitude towards EBF. The finding is slightly greater than reports done in Rwanda, Kigali, which was 71.1% [
In this study, 66.4% of study participants have information about EBF and their source of information was health institutions. This is more than the study conducted in Mizan Aman town, Southwestern Ethiopia, which was 62.7%, while it is much less than the study conducted in Kigali, Rwanda, that was 74.4 [
Knowledge of study participant mothers who attend ANC and immunization clinic towards exclusive breast feeding (EBF) is poor which is less than three-quarters. However, positive attitude towards EBF is more than three-fourths in this study. Based on this conclusion, health care workers who work in the areas of MCH clinic are better to give appropriate information about EBF to mothers who follow ANC and for those who come to immunization. In addition, health care providers who work in the areas of MCH should evaluate mothers’ knowledge and attitude for every visit by asking questions related to EBF, health care officials of Dabat Health Center may play their role by actively following activities of health care providers of MCH, and health project implementers shall support and arrange training program for health care providers of MCH to improve mother’s knowledge and attitude towards exclusive breast feeding.
A questionnaire prepared to assess Knowledge and Attitude towards Exclusive Breast Feeding among Mothers Attending Antenatal and Immunization Clinic at Dabat Health Center, North West Ethiopia, 2016.
Hello! Good morning/good afternoon, my name is —————— and I am a data collector from university of Gondar, school of nursing. Thank you for allowing us to share your precious time and for your willingness to participate in this study. The objective of this study is to assess knowledge and attitude of mothers towards exclusive breast feeding, among Mothers Attending Antenatal and Immunization Clinic at Dabat Health Center, Northwest Ethiopia. You are chosen to participate in this study and the study will take about 10 minutes to complete the questionnaire.
We would greatly appreciate your help in responding to this survey.
Are you willing to participate? Yes No
Thank you for voluntarily participate in the study!
See Table
Questionnaire used to collect the research data.
Sociodemographic characteristics
Sr. number | Question | Response | Remark |
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Age | —————— years | |
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Religion | (1) Orthodox |
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Ethnicity | (1) Amhara |
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Marital status | (1) Married |
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Educational status | (1) Not able to read and write |
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Occupational status | (1) Government employee |
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Residency | (1) Urban |
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Parity | - - - - - - - - - - | |
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Gravidity | - - - - - - - - - - | |
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ANC follow-up | (1) Only one time |
Questions about knowledge of mothers towards exclusive breast feeding
Sr. number | Question | Response | Remark |
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Do you know about exclusive breast feeding? | (1) Yes |
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What is your source of information? | (1) Friends |
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Right time to give breast milk? | (1) After giving some butter |
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What do you do with the first milk or colostrum? | (1) Discard |
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What is the right time to start complementary foods? | (1) 3 months or less |
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What are the foods and/or fluids recommended to give a child under 6 months? | (1) Only breast milk |
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Is prelacteal feeding needed for an infant before starting breast milk? | (1) Yes |
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Is breast milk alone being enough for an infant during the first 6 months of life? | (1) Yes |
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Is exclusive breast feeding for the first 6 months used to prevent diarrheal and respiratory diseases for the infant? | (1) Yes |
Questions related to attitude of mothers towards exclusive breast feeding
Sr. number | Questions | Response | Remark |
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( |
Giving breast milk for a newborn immediately within an hour after birth is important? | (1) Strongly agree |
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Discarding the first milk or colostrum is important before giving breast milk to a newborn? | (1) Strongly agree |
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Giving a child of three months only breast milk may not be sufficient and a child needs water and other fluids to prevent thirst? | (1) Strongly agree |
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Starting complementary foods to a child before six months is important? | (1) Strongly agree |
The authors declared that there are no conflicts of interest.
Mulugeta Wassie Alamirew carried out the paper’s conception, analysis, and interpretation of data and drafted the paper; Netsanet Habte Bayu participated in data collection and analysis; Nigusie Birhan Tebeje participated in data analysis, interpretation, and review of the paper; Selam Fiseha Kassa participated in data collection and analysis. All authors read and approved the final draft of the paper.
The authors’ great gratitude goes to University of Gondar College of Medicine and Health Science School of Nursing for providing logistic and material support to conduct this research. Finally, the authors’ heartfelt thanks go to the supervisors and data collectors for their admirable endeavor during the data collection.